TWiP 103: Scroll down, please

TWiP

Echinococcus granulosus adultHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Michael Libman

The TWiP-scholars solve the case of the Housewife from Kolkata, discuss mutations in the IL17 gene associated with cerebral malaria, and hear a case presentation from guest Michael Libman.

Download TWiP #103 (53 MB .mp3, 68 minutes)

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 Case study for TWiP 103

This week’s case concerns a 42 yo male, refugee in Canada, from DRC, former Zaire, where there is unending civil war. Upper middle class, professor of French at university. Had been imprisoned, tortured, lived in jungle for a few years, reached refugee camp in Tanzania, moved to Canada. Came to health care system 15 months after arrived. Was sent to psych, unstable emotionally, delusions, hallucinations, depression, post traumatic issues. Was under psych care for ~1 yr, did not improve, became worse. Sent to hospital. History: talked about having minor injury, hurt lower back, pain there bothering him. Some anemia (normochromic), basic hem/chem/urine/liver nothing remarkable. Physical exam, nothing remarkable. HIV negative. Some evidence for chronic inflammatory condition: sed rate 60 (elevated), had diffuse increase in IgG, IgM. Developed some low level autoantibodies; anti-nuclear, p-anka, anti-neutrophil cytoplasmic antibodies. Slightly elevated fever for a few days, then few days or week with no fever. No eosinophilia. Radiology: on CT did have some mediastinal, aortic, axillae lymphadenopathy. Prob screened in Africa for malaria and treated; prob also got ivermectin. Also got head MRI: not completely normal, classic nonspecific midbrain abnormality. Diffuse mild edema. Weight loss not remarkable. No visual problems.

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TWiP 102: Nursing eosinophils

TWiP

nurse cellHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPyzoites solve the case of the Uncommon Parasite, and discuss the role of eosinophils in promoting the growth of Trichinella in skeletal muscle.

Download TWiP #102 (76 MB .mp3, 100 minutes)

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 Case study for TWiP 102

This week’s case involves a 24 yo housewife, from a village outside of Calcutta. Comes into a tertiary care hosp, 6 months coughing up blood, fever, no weight loss. Drinks rainwater, milks her cow. Dogs everywhere, no livestock except cows. Eats meat, well cooked. No extramarital encounters. Husband well. 4 children. Cistern for drinking water is covered.  No health issues. Reports salty, clear mucus. No blood in stool, no changes in stool. Exam: looks healthy, lungs clear. Lab tests: White count of 9000, 12% eosinophils (elevated). So she has eosinophilia. Chest X-ray and CT: lesion on left side in xray. CT: shows 4 cm cavity, with air pocket on left side, mid-lung. HIV negative. Dusty soil, birds.

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TWiP 101: Is it round or is it flat?

TWiP

Opisthorchis viverriniHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The doctors TWiP solve the case of the Woman with White Worms, and explore the role of a secreted growth factor from a carcinogenic parasite in wound healing and angiogenesis.

Download TWiP #101 (84 MB .mp3, 111 minutes)

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Listener Pick

Ramon – Ancient Rome was infested with parasites

Case study for TWiP 101

This week’s case involves an uncommon parasite. Young girl, <10 y, brought in by parents from rural area to regional hospital with fever, diarrhea for 2 weeks. No blood in stool. Parents: few weeks prior to problems, young girls went with family on wild pig hunting trip. With guns. Girl did consume pig on trip, all meat was very well cooked. Was involved with preparation of meat with Mother only. No one else got sick. No surgery, no allergies. Both parents have diabetes. Has four brothers. Some weight loss. This is outside the US. Physical exam: low grade fever, diffuse mild abdominal discomfort, slight microcytic anemia, size of cells is slightly smaller than normal. WBC: normal, except no eosinophils. Blood cultures negative. Stool examination is where we get our answer.

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TWiP 100: Driving past a milestone

TWiP

Cas9 mediated gene driveHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiP trifecta solves the case of the Woman from Bolivia with Belly Pain, and discuss a method for population modification of malaria mosquitoes using a Cas9-mediated driver gene.

Download TWiP #100 (85 MB .mp3, 113 minutes)

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Case study for TWiP 100

This week’s case is a 27 yo female, native NY, referred to outpatient at CU after seeing OBGYN, told had seen worms in stool and underwear. Inch or two in length, pale white, round, moving, 2-3 weeks of constant abdominal bloating. Sexually active. No particular diet. Travel: works for NGO, refugee camp in Ethiopian-Sudan border, southern Sudan. Last visit month ago. Noticed worms when she got back from last trip. Eats what local people eat. Raw food popular there: kitfo, raw steak tartare, with melted butter. Made from local beef. Did not take malaria prophylaxis, did not avoid local water, does wear sandals. College graduate. Nothing remarkable in family. CBC, liver, metabolic: all normal. Stool not normal: loose, no mucus or blood.

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TWiP 99: You get your polar bear from your nana

TWiP

H nana adultHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiP trifecta solves the case of the Professor Who Went to Brazil, and discuss an amazing case of a tapeworm that turned into a tumor in an AIDS patient.

Download TWiP #99 (72 MB .mp3, 100 minutes).

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Case study for TWiP 99

This week’s case is a 53 yo woman visiting family in US, comes in with intense belly pain, right upper part of belly. Has become strict vegetarian after having breast cancer, on raw vegetable diet (carrots, collect plants in local markets). From Bolivia. Lives in agricultural area, avoids sheep, fearful of dogs. Housekeeper. Married, lives with husband. Noticed pain when came to US. Breast cancer: localized, removed lesion, no therapy, months ago. No allergies, family healthy. No insect bites, lives in concrete house. Physical exam: not febrile, right upper quadrant is very tender, some liver enlargement. CBC: 10,000 white count, mostly eosinophils, liver function: AST, ALT, AlkPhos all normal. Neuro exam: normal. Five months before this diet, she did have normal diet. Some meat, drank milk.

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TWiP 98: Resistance is not futile

TWiP

BalamuthiatropHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiP-lets reveal Balamuthia infection in the Children from Peru, and discuss resistance to pyrethroids uncovered by RNA sequencing of Anopheles mosquitoes.

Download TWiP #98 (70 MB .mp3, 97 minutes).

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Case study for TWiP 98

This week’s case is a Professor clinician, teacher, researcher.  In his 50s, he presents with lesion on big toe, anterior portion, tip, nodular. No surrounding redness, area is itchy. Has a small central black area the size of pencil tip, concerned because feels is getting larger over last week. Spooky. Travels, last in Brasil, had been for a few weeks, noticed toe issue a week after returned. Spent time on beach, but wore flip flops. Different types of beaches, crowded and not crowded. Went with wife. Healthy man, no prior medical problems.

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TWiP 97: The seven year itch

TWiP

Sarcoptes scabei 2Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The paratenic hosts reveal a case of scabies in the Traveling Salesman, and discuss a role for natural antibody in protection from infection with Plasmodium.

Download TWiP #97 (63 MB .mp3, 87 minutes).

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Case study for TWiP 97

Daniel has two cases this week. Two people with similar presentations. A 12 yo girl in Peru presented for care with painless dark brown area on right knee. Has brothers and sisters, often play together. No trauma, but area is expanding. Months later develops cognitive changes. Second case is a 5 yo boy from the coastal region of Peru brought in by Mother, has red swollen area on face. Mom says while playing scratched nose, swelling right cheek, eye, nasal obstruction, no response to antibiotics. MRI of both show infiltrating process. Girl, left side of brain, middle cerebral artery territory. Boy in frontal region, midline area. Thus both skin lesions associated with infiltrating process in brain. Came into clinic months after lesions started, and lesions still present.

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TWiP 96: Salivary pharmacopeia

440px-Lutzomyia longipalpis-sandflyHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPanosomes solve the case about the Young Woman who Went to Belize, and relate how sandfly saliva skews the immune response and increases risk of cutaneous leishmaniasis.

Download TWiP #96 (76 MB .mp3, 104 minutes).

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Case study for TWiP 96

Daniel’s patient for this week is male patient referred for consultation by OB-GYN: his wife is pregnant, has been admitted and is about the give birth. It is her first pregnancy. There are concerns about the husband’s skin problem and whether it is a threat to his pregnant wife. No lesions on woman, husband recently developed itchy skin problem on his hands. Bilateral. Small papules on webs of fingers, brown lines, blood clots at ends, has clearly scratched the lesions. Skin between fingers is involved. Travels, often stays in cheap hotels. Beds not clean. Last trip 1 month before symptoms.  Midwest travel. Family history of heart disease. Sales occupation. No animal exposure. Travels to medium to large cities.

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TWiP 95: Arsenic and Leishmania

leishmania - leishmania tropica.jpgd15978d9-81d0-42c7-839b-d32b1550f31dOriginalHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Vincent, Dickson, and Daniel solve the case about the 33 year old Chinese male with watery diarrhea, and discuss whether arsenic in drinking water might lead to treatment failures for Leishmania infections.

Download TWiP #95 (77 MB .mp3, 105 minutes).

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This episode is sponsored by ASMGAP

Case study for TWiP 95

Daniel’s patient for this week is a 28 yo single female, returns from beach vacation with new boyfriend. Two weeks in Central America (Belize). Often found secluded beaches. Good health, noticed upon her return had small nodules/papules on front of thighs. Thought were insect bites, became very itchy. Noticed serpiginous red lines forming, radiating out from bumps. Felt things moving in her skin. Benadryl did not help. Daniel say something similar occurs in Lima. Healthy, no allergies, surgeries, no relevant family history, using barrier contraception, sexually active. Only drinks alcohol socially. Boyfriend did not report symptoms. She did lie on sand, used thin fabric. Stayed in hotel. There were wild dogs on beach. During her stay she ate ceviche. No intestinal symptoms.

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TWiP 94: Loa hanging fruit

Bcr abl STI 1IEPHosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Vincent, Dickson, and Daniel solve the case about the man from El Salvador, and discuss the use of tyrosine kinase inhibitors to treat onchocerciasis and filariasis.

Download TWiP #94 (74 MB .mp3, 102 minutes).

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Case study for TWiP 94

Daniel’s patient was seen in the clinic. He is a 33 yo chinese male, from Chinatown NYC, for several months on and off has had watery diarrhea, headaches. Tried reflexology, chiropractic therapy, with no results. Has traveled quite a bit, been in Chile (was there a few months before). Came to US when young. Grew up in the US. In Chile, has had many sexual partners, >50, of both sexes, also has done many drugs. Two years ago was diagnosed with chronic HIV, CD4 count 685, on ARVs triple therapy, virus loads are well controlled. Has had syphilis, nose job, no medication allergies. Lives with family. On exam, afebrile, looks well. Symptom onset a few months after last Chile visit. Is an adventurous eater.

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